Module 4

Multiple Select

Which of the following are characteristics of EHR-based clinical decision support systems for antibiotic stewardship?

• They generate actionable clinical alerts within the EHR

• They require users to access a separate system for alerts

• They can influence antibiotic use at the point of order entry in real time

• They are typically more retrospective in nature

Multiple Choice

Why is antimicrobial stewardship important in the inpatient setting?

• It helps achieve optimal clinical outcomes and reduces antimicrobial resistance.

• It increases the cost of healthcare.

• It encourages the overuse of antibiotics.

• It eliminates the need for infection control programs.

Open Ended

What are some challenges faced when implementing preauthorization and prospective audit and feedback strategies in antimicrobial stewardship programs?

Multiple Choice

Which of the following is NOT a benefit of implementing facility-specific clinical practice guidelines for antibiotic use in hospitals?

• Increased likelihood of adequate initial therapy

• Use of broader spectrum antibiotic regimens

• Earlier switch from IV to PO therapy

• Shorter duration of treatment

Open Ended

Describe two strategies that can be used to optimize antifungal dosing in hospitalized patients, as discussed in the text.

Multiple Select

Which of the following are important considerations when making a business case for an Antimicrobial Stewardship Program (ASP) to hospital leadership?

• Learning hospital or system priorities

• Understanding how decisions are made by leaders

• Focusing only on clinical outcomes

• Making the proposal clear and value-focused

Open Ended

Explain why it is important to adjust for patient days when comparing antibiotic use metrics across different hospitals or time periods.

Multiple Choice

What is a commonly used metric for measuring aggregate antibiotic use in hospitals?

• Median duration of therapy

• Incidence density rate of defined daily doses

• Total number of prescriptions

• Average patient length of stay

Multiple Choice

What is the main difference between Defined Daily Doses (DDD) and Days of Therapy (DOT) as metrics for measuring antimicrobial use?

• DDD sums total grams of drug and divides by a standard dose, while DOT counts the number of days a patient receives any dose of a drug.

• DDD counts the number of days a patient receives a drug, while DOT sums the total grams of drug used.

• DDD is only used for pediatric patients, while DOT is used for adults.

• DDD is a subjective measure, while DOT is objective.

Open Ended

List and explain two primary ways to quantify aggregate antimicrobial resistance data.

Multiple Choice

Why is it important for the Antimicrobial Stewardship Program to understand how antimicrobial resistance data was gathered, filtered, and reported?

• Because the way data is processed can substantially impact the apparent level of resistance.

• Because it helps in reducing the cost of laboratory tests.

• Because it ensures that only resistant isolates are included.

• Because it allows for faster reporting of results.

Multiple Choice

According to the recommendations for reporting aggregate antimicrobial susceptibility data, what is the preferred approach regarding multiple isolates from the same patient?

• Include only the first isolate per patient per time period.

• Include all isolates regardless of time period.

• Include only isolates from ICU patients.

• Include only isolates from outpatient locations.

Open Ended

What are some challenges in using your own institution's data for benchmarking antimicrobial stewardship metrics, and how can these challenges be addressed?

Multiple Choice

What is the main advantage of using interrupted time series analysis in evaluating the effect of an intervention on antimicrobial utilization?

• It compares only the mean values before and after intervention

• It accounts for underlying trends and changes in slope and level

• It ignores random variation in the data

• It requires fewer data points than other methods

Multiple Select

Which of the following are challenges or considerations when benchmarking antimicrobial use across institutions?

• Differences in patient mix

• Obtaining data from peer institutions

• Uniformity in antibiotic prescribing practices

• Potential for error in data collection

Open Ended

Explain how the Standardized Antimicrobial Administration Ratio (SAAR) is used to benchmark antimicrobial use in hospitals.

Multiple Choice

What is the primary function of a clinical decision support system in antibiotic stewardship?

• To replace the clinician's decision

• To generate patient-specific recommendations based on clinical data

• To collect billing information

• To monitor hospital finances

Open Ended

Describe how the integration of data streams in third party clinical decision support systems differs from EHR-based products.

Multiple Choice

What was a major limitation of antibiotic clinical decision support systems in the mid to late 1990s?

• Lack of integration with EHRs and fragmented data sources

• Too many automated alerts

• Overuse of antibiotics

• Excessive cost of implementation

Multiple Select

Which of the following are benefits of using technology to identify antibiotic stewardship opportunities?

• Increased efficiency

• Reduction in manual chart review time

• Cost savings

• All of the above

Open Ended

Explain how clinical decision support systems can help improve medication safety beyond infectious disease alerts.

Multiple Choice

What are two main cost categories associated with implementing clinical decision support systems?

• Out of the box costs and additional investment for extra features

• Hardware costs and software costs

• Training costs and maintenance costs

• Personnel costs and licensing fees

Open Ended

Reflecting on what you have learned about antimicrobial stewardship interventions, what is one strategy you think could be most effective in your own clinical practice or healthcare setting, and why?

Multiple Choice

What are the main goals of formal antimicrobial stewardship programs in the inpatient setting?

• To achieve optimal clinical outcomes related to antimicrobial use and minimize toxicities

• To increase the use of antibiotics regardless of resistance

• To focus only on reducing healthcare costs

• To eliminate the need for infection control programs